Emergency medical services are a step closer to seeing financial relief after the state House on Monday approved legislation to increase the Medicaid reimbursement.
House Bill 699 would increase reimbursements for Advanced Life Support services from $200 to not less than $300, and for Basic Life Support services from $120 to $180. The rates were last changed in 2004.
“The current reimbursement rates come nowhere near covering actual costs. In fact, they are more than 200 percent below reimbursements provided by Medicare and commercial insurance,” said state Rep. Martin Causer, R-Turtlepoint. “Ambulance services that care for a high volume of Medicaid patients cannot continue to provide these life-saving services without additional support.”
The Medicaid reimbursement rate was among challenges pinpointed by the Rural EMS Task Force that includes ambulance officials, health care providers and other groups across McKean, Potter and Cameron counties.
“Access to emergency medical services can mean the difference between life and death for many patients, and that is especially true in rural areas where many people live far away from local hospitals,” Causer said.
What’s more, state Rep. Matt Baker, R-Wellsboro, said misconceptions exist in that EMS agencies bill and receive full payment for services.
“Fifty to 70 percent of all reimbursement comes from Medicare, government contracted (Managed Care Organizations) and Medicaid,” he said. “Programs are fee for service and payment rates are pre-determined.”
Medicare reimbursements are based on a fee schedule put in place in 2002, while Medicaid’s dates back to 2004. Baker said that 40 to 60 percent of EMS encounters involve patients with Medicare, whereas 10 to 30 percent include patients with Medicaid.
“Senator (Joe) Scarnati understands the importance of this issue and is supportive of the legislation pending an analysis of the full cost to the Commonwealth,” said Kate Eckhart Flessner, Scarnati’s communications director.
The EMS must not –– and should not –– be treated as a transport service, Baker said.
“EMS is healthcare, healthcare that is needed immediately. Without it people will die,” he said. “EMS is like a field hospital, an ER on wheels. How else do we get critically ill or injured patients to a hospital?”
Under law, EMS is required respond to a 911 call, no matter the patient’s ability to pay, Baker said.
“EMS must be available 24/7 whether they receive two calls a day or 20 calls a day,” he said. “EMS does not receive payments/reimbursement after responding to a 911 call when a patient refuses to be transported after receiving treatment. This does not happen anywhere else in healthcare.”
In other news, the state House passed Bill 1013, which would allow for reimbursement when treatment is provided but transport does not occur. The BLS or ALS unit would have to be dispatched by a county 911 center, and the EMS provider must have rendered care even though the transport was declined, according to information from Causer.
Bills 699 and 1013 are awaiting consideration in the state Senate.
